Tuesday, February 26, 2013

Texas: Never Too Sick for Death Row


Oy, if you're very sick and very dangerous, Texas is not the place to be. Oh, it never was and maybe it never will be.  

In Maryland, if someone is in the hospital and wants to leave, the vast majority of the time, they get leave.  If the staff thinks they should stay, they get to sign a leaving AMA form --against medical advice.  In rare instances, if a voluntary patient wants to leave, but they are felt to be imminently dangerous, then they can be certified, and held on the floor until there is hearing.  At the hospital where I did my residency, hearings were held on Wednesday when an administrative law judge came in for that purpose, so how long a patient was stuck there without 'due process' depended on what day of the week this went down.  In Texas, you can be committed against your will, but apparently as I've learned from yesterday's New York Times, if you've signed in, you can't be held and committed, no matter how sick, psychotic, and dangerous you are.  Really?  I'm back to my original thought: oy!

From Advocates Seek Mental Health Changes, Including the Power to Detain:


Mr. Thomas, who confessed to the murders of his wife, their son and her daughter by another man, was convicted in 2005 and sentenced to death at age 21. While awaiting trial in 2004, he gouged out one of his eyes, and in 2008 on death row, he removed the other and ate it. 

At least twice in the three weeks before the crime, Mr. Thomas had sought mental health treatment, babbling illogically and threatening to commit suicide. On two occasions, staff members at the medical facilities were so worried that his psychosis made him a threat to himself or others that they sought emergency detention warrants for him. 

Despite talk of suicide and bizarre biblical delusions, he was not detained for treatment. Mr. Thomas later told the police that he was convinced that Ms. Boren was the wicked Jezebel from the Bible, that his own son was the Antichrist and that Leyha was involved in an evil conspiracy with them. 

He was on a mission from God, he said, to free their hearts of demons. 

What a travesty.   And here in Maryland,  yesterday a court sent a 15 year old boy, tried as an adult, to prison for life, commuted down to 35 years, for a school shooting / attempted murder.  The boy took his step-father's gun, which fortunately,  was not a rapid fire weapon, but a shotgun (I think), and before he could get too many rounds fired, a heroic teacher tackled him and the single wounded victim survived.  The boy left a suicide note, but his plan to die that day was foiled.  He's reportedly been improving with treatment in a county detention center, and he pleaded guilty to the charges, no insanity defense sought, no trial necessary, just a hearing for sentencing.  I won't comment on whether I think it serves society to send a child to prison with adults for 35 years.  

To those who oppose involuntary hospitalization under any conditions at all, I have to ask, what do you think should be done if you become so psychotic that you believe it's necessary to kill your own children and eat your own eyeballs?  In Texas, it's clear: you're free to do so and the state will just kill you. 


29 comments:

Anonymous said...

This was a horrific case. There have always been horrific cases. There will always be horrific cases. But as a society we do ourselves tremendous damage when we legislate to try to control the furthest edges of the extreme. For proof of this, we need look no further than the post-911 excesses of the Patriot Act and the indefinite detention and torture of people on the flimsiest of suspicions. Until you can convince me that anybody can definitively predict dangerousness, I will continue to maintain that people should not be incarcerated against their will, merely on the chance that they might become dangerous.

ClinkShrink said...

I guess that's the trick, isn't it? At what point does "merely a chance" become certainty? Since in theory a meteor could drop and destroy a city block at any time, then really nothing in the future is guaranteed is it? So what you're proposing is essentially that psychiatrists should never act to prevent violence regardless of the level of risk. If someone tells me she's planning to kill her husband, her kid and family dog in order to save the world and that she'd accumulated enough dynamite to do it, I should do nothing? What about the next door neighbors and other innocent bystanders---shouldn't they as part of a society have something to say about this?

The "never incarcerate the ill" theory only works so far as your actions only affect you. Once others risk getting hurt, society gets to have a say in what happens.

Dinah said...

I'd also like to point out that while we have heard some awful stories from our readers about how they've been treated in hospitals and I respect how distressing this can be, psychiatric hospitals are not akin to indefinite detention and torture. Sometimes patients are hospitalized because of a miscommunication or misunderstanding. After a day or two on an inpatient unit, when there is the chance to observe that their behavior is not disorganized, they either aren't psychotic, or aren't obviously dangerous, they are discharged. If they remain, there is a hearing, and patients are sometimes released by a judge. Most of the patients in psychiatric hospitals are they voluntarily because they want help, these are not Guantanamo. It's not that I think the system is perfect, there are mean people in any system, mistakes, injustices. I want a gentler system, but there is no way to get an absolute perfect catch of all who are dangerous and none who aren't for even a few days.

You can also be arrested for a crime you didn't commit and serve months to years in jail while you await trial, one that may well acquit you after taking years of your life. Why don't people complain so bitterly abut that?

jesse said...

At first I was swayed by Anon's eloquence, then realzed that her argument makes exactly the opposite point intended: she IS trying to legislate for the extremes. In the great majority of cases when two psychiatrists examine a patient and find him a danger to self or others, the patient in fact is indeed that and the judge agrees. That is because they are not certifying the patient randomly, nor simply listening to his statements, but are trained observers going on information gathered in the interview. As Dinah pointed out, for instance, the patient might be psychotic or disorganized, severely depressed, or has already begun the acts he speaks of.

jesse said...

To be more clear, it is the extreme case in which the psychiatrists are dead wrong in these commitment cases. The inability to predict violence of which Dinah was speaking in regard to the gun laws applies to people who appear reasonable normal at the time of application for a license. It is for those people that we cannot predict that in the future they will use the guns for violence.

Anonymous said...

Dinah,

Once again, you're passing the buc regarding how horrible inpatient hospitalization is. If it isn't so bad, why did those folks I previously mentioned on this board avoid telling their therapist they were suicidal out of fear of being committed?

And yes, there have been indefinite voluntary commitments that would have continued if Mind Freedom hadn't stepped in. But you conveniently ignore those.

I disagree vehemently that psychiatric hospitals aren't torture. If you drug someone against their will as punishment, that is torture plain and simply. If you put someone in 4 point restraints when they have done nothing to merit that, it is torture. Sorry Dinah, a spade is a spade.

I remember a blog by someone who posted about her son who was bipolar and discussed an inpatient hospital experience and mentioned how she felt he was medicated with extra drugs as punishment. She was not anti psychiatry at all.

You all just don't seem to want to admit that your profession has alot of abuses in it. Instead you would rather blame us for not fighting other issues that in your eyes are more important.

Anonymous said...

Jesse--you say it is the extreme case in which psychiatrists are dead wrong in an involuntary committment. With all due respect (and I do respect you based on the totality of what I've read), you can't possibly know that, because you can't prove a negative. In other words, you can't prove that any patient that was hospitalized against his or her will would have gone on to commit violence, but-for the ivoluntary incarceration.

Dinah--You point out that there are also injustices in the criminal system and I agree. But as my Daddy taught me a million years ago, two wrongs don't make a right.

Clink Shrink--Based on your hypothetical, maybe "definitive" is too high a standard of proof. But I think that for forced psychiatric incarceration, beyond a reasonable doubt should be the applicable standard. And I think there should be immediate judicial review (wihin 24 hours). And I think the person involuntarily incarcerated should have the right to assistance of counsel and experts of their own, at the state's expense. Perhaps it's possilbe to provide a level of due process that's constitutionally adequate.

First Anonymous Poster

Joel Hassman, MD said...

What is the purpose of the state of Texas? Not where hope goes to die, but further, where hope goes to hell.

Maybe they should secede from the US.

Mexico would be happy?

Anonymous said...

I agree with the first anonymous' comments. Not fair to make one targeted group pay for the sins of someone else.

I have been a patient in a psychiatric hospital in Texas, and my experience was that I left a whole lot worse than I went in. I hope the laws in this state do not become more lax making it easier to commit someone or hold them longer.

I have talked before about my experience as an involuntary patient who was classified on paper as a "voluntary patient." But, if we are going to talk about hospitalization it's important to talk about what that can actually look like. I will give you a glimpse of what it can look like in Texas.

Late 90's I was verbally threatened by medical staff that if I did not sign an informed consent document for hospitalization I would be forced to do it. They stated if I did not sign the informed consent it would "be harder to get out." Thus, I signed and became an involuntary, "voluntary" patient. I verbalized that I was not in agreement with what I was signing. I wrote in the informed consent document that I was signing under threat and that I did not agree with what I was signing. I marked out that I was agreeing to a 72 hour hold and wrote in 24 hours. Apparently they were completely unaware that threatening people to sign informed consent is not informed consent, as a key component of the process is that it is voluntary.

They also should have known that when patients alter the content of the informed consent document it invalidates the document. Regardless, I was hospitalized involuntarily as a voluntary patient. Further, they told me that if they decided I was not ready to leave in 24 hours since it was a Friday and judges don't do weekends, I would have to wait until Monday for anyone to address it. I guess they told me this to make me feel even more scared.

Then, as a voluntary patient who was hospitalized without a valid consent, I was forced to strip and put on scrubs with block lettering on the back on the top, to give it that prison feel I guess. The nicer hospital in the same city, incidentally, does not strip psychiatric patients. I committed no crime other than being pretty sad.

The psychiatrist at the hospital was clueless. He seemed surprised and miffed that an involuntary patient wasn't interested in chit chatting with him about the weather and the origins of my last name. He also said helpful things like, "You're a pretty girl, what do you have to be sad about?" Brilliant.

24 hours later I was supposedly all fixed up even though I felt considerably more depressed than when I was admitted. I was supposedly so sick that I needed constant supervision one minute to being discharged with no way home and no one even bothering to inquire about it. I was there without a vehicle and no credit card so couldn't call a cab. They finally gave me a bus ticket (and if you've been to Texas you know that we aren't exactly known for public transportation) and the bus didn't drop me off anywhere near my home. I had to walk across a busy freeway to get home. That was a tremendous waste of money and resources, and they put me in danger.

I refused to see another psychiatrist for over 10 years after that experience. The one I have now doesn't do the force thing. He treats me like an adult, with respect and kindness. That works a whole lot better than threats and ultimatums.

Dr. Hassman,

Psychiatric hospitals in Texas may suck, but we do a lot things right here. I grew up on a farm way out in the country and we had the most beautiful sunsets. Wide open spaces. Nothing like riding horses through open fields where all you see is earth and sky. I am also a bit biased about our bbq. We know how to make it.

jesse said...

@First Anonymous Poster: From what I have seen and heard the great number of involuntary certificates that are signed by psychiatrists (two signatures required) refer to self harm. It is much less likely that harm to others is the issue. The patient does not merely mention words like suicide, but is showing a variety of symptoms that indicate severe depression, for example, with plans for suicide made and ready, with good reason to believe it would be accomplished. In the cases I've seen the patient was later grateful to have been stopped.

Once I treated a very depressed woman who had been walking on the railroad tracks hoping that a train would kill her. She volunteered this and when I called a family member to take her to the hospital she agreed to a voluntary hospitalization and later was glad she had been stopped.

Another time I thought a patient sounded completely irrational on the phone, went to his apartment and found that he had pried out the electric outlets in his living room with a screwdriver (a metal one!...) because the devil had been talking to him through them. I signed a petition to have the police pick him up.

What would have happened without these interventions? Yes, there is no certainty, but I have found most psychiatrists to be thoughtful, caring people who very much care about the rights of their patients and try to do the best thing. Perfect? No.

I think often in the comments here posters forget that the alternative to psychiatrists taking some action is that the behavior of the individual has created alarm in other people. They call the police, enlist family members, and so on. The alternative to psychiatrists is something often far more controlling and unhelpful.

Anonymous said...

Jesse--I appreciate your thoughtful response. My original comment was directed toward the issue of legislatgion aimed at making it easier to involuntarily commit a person based on a prediction of dangerousness to others. I hadn't really thought through the issue of suicidal persons.

On the subject of suicide, I'll say this. I've never attempted suicide. About 30 years ago I sat in my living room and pointed a loaded gun at my head. Then I put my finger on the trigger. Then I took my finger off the trigger and put the gun back down. So had I gone through with it, my first attempt would have been my last. After that, I made a conscious decision that I would just take suicide off the table with myself. So, although I've felt suicidal since then, actually prayed and begged God to just let me die, I've already decided I won't kill myself. I reserve the right to change my mind, though, and as someone sitting here with a successful career, a house of my own, good relations with friends and family, totally competent and, at this moment, totally non-depressed, I can tell you that if I decided to kill myself, I would not want anybody to lock me up against my will. I would want somebody to talk with me, more like listen to me. And then I would want that somebody to respect my choices.

Which brings me to my final point. I think the fear of being involuntarily hospitalized due to suicidal ideation can, in some circumstances, contribute to the very harm hospitalization is intended to prevent. If a person, such as myself, is feeling suicidal, it would be very helpful at times to discuss it with a therapist or some other person. But I would never do that for fear of being locked up.

I guess there's no one size fits all.

First Anonymous Poster

jesse said...

@FAP, I agree with you almost completely, really, but with a twist: what you would prefer, to sit with someone and talk about it, is what most psychiatrists would prefer, too. I have had patients who have talked for many years about thoughts of suicide and wanting to die. That is what we do: talk with people and help them through very difficult times, even decades of difficult times. And without hospitalizing them if at all possible.

jesse said...

@FAP and others: this thread made me think about the question of the forced hospitalizations in a very different way. It seems to me that I, and Dinah and the psychiatrists I know, live in a very different world from that of many of the patients who post here. I was trained in doing long term therapy at an institution where patients lived often for years. Zelda Fitzgerald once was there. We learned to sit and be with very disturbed patients without feeling threatened or having the need to "do" something right away. So today I have had quite a few patients who have suicidal feelings, self destructive urges, crazy destructive thoughts for years and I understand that they will not act on them.

But those people are my patients. At other times I have had to see patients brought to an emergency room by their families, friends, or police. Something had broken down and those people were not in the same place as the people I see in my office. There, in the ED, the chances that the patients would be certified are higher, as there had been a crisis and everyone around them is afraid. Otherwise they would not be there.

I think that the patients who have had these bad experiences more likely came in from this alternate route.

But even still, there are very few Nurse Ratcheds out there, and most of the time the staff is trying to do its best in a difficult situation. So there is truth in saying that we cannot predict the future in those instances, but we have to use our best judgment. I know some of the administrative law judges, as well as the lawyers who serve to protect the rights of the patients, and they, too are caring people.

So I would urge those who have had bad experiences to consider that theirs is not the norm. Often here a person posts about one bad experience he had and them writes as if all hospitals, all psychiatrists, even the entire science and profession of psychiatry, is wholly bad.

This comment might have been a blog, and I want to hear what the readers here think, so please let me know.

Joel Hassman, MD said...

Perhaps my earlier comment about Texas was a harsh overgeneralization, but, the politicians who set the laws are elected by the public, so, to those who disapprove of the way the state has operated for the past, what, 30 years or more, time to rally the independent voters to support more public need and not partisan party platitudes?

But, my comment now is again to reflect what do people expect the mental health system to do with people who are disruptive in the communities, who are risks to themselves or others, who will not make sincere efforts for change and respect their interactions in the community involve others?

People complain bitterly that correctional facilities should not be defacto mental health centers, but, what else will be done if involuntary admissions are so taboo, so outlandish, so harmful as some allege here as equal overgeneralizations?

The road to hell is paved with good intentions, I know and accept that adage, but, better to do too much and be hated by the patient who has choice in the future, than relatives and affected others in the community who are further outraged and possibly harmed by a status quo of nothing.

The other adage that hurts to hear, but is valid to me, the needs of the many outweigh the needs of the few.

Anonymous said...

Jesse,

I agree that your experiences are different, however I wonder how familiar you are with inpatient psychiatric care in Texas. Please do not assume that my experience is just one bad experience. I do not believe my experience is uncommon, and I know this because I have personally observed inpatient psychiatric care (not as a patient) in other hospitals. So, all of my data and opinions about it do not come from one hospitalization. I also have friends and family who are nurses and doctors in Texas. And, as I said I have personally observed other psychiatric hospitals than the one I was in years before. It's bad, and the first step for there to be any change is for people to own the problems. Until then these hospitals will undoubtedly continue to spit out patients who are more distressed than when they were admitted. This is not good for patients, and it is not good for society. I even know of one PA who changed her focus during schooling because of disgust with the treatment of patients in a psychiatric hospital here. That's not a good sign.

It's not enough to say the terrible care received inpatient is well intentioned or whatever else, if the outcome is more damage to patients. I want for patients to be treated with the same decency, respect, and kindness that I have received in an outpatient setting because that is what changes peoples' lives. That is what leads to patients trusting the physician enough to take medication. There is no way I would have swallowed any pills with the threats and so on that go on in an inpatient setting because that does not lead to the establishment of any kind of trust.

You should be able to google for an article about a psychiatric hospital in Texas (I think it was called West oaks) that didn't even notice a little girl had a broken arm. THe reason for this is that very little time is spent actually talking to patients. Sadly, it didn't surprise me in the least when I read it. Texas inpatient psychiatric care is not good. Maybe it has something to do with Texas being at the bottom of mental health care spending that leads to this type of treatment, I don't know. But, what I do know is that they need to do better.

Anonymous said...

Dr. Hassman,

Please do not assume that the article is correct. I know that hospitals keep patients against their will without the proper paperwork, because I have been a patient. They put me in a cage (tiny room with a metal door and mesh covered window) when I was brought in by a therapist (not a police officer), and a security guard stood outside the door until they got the paperwork they needed even though I was not talking. So, I'm not getting the article's claim that hospitals cannot hold patients, because they certainly do hold them.

I think the article said the patient was in a hospital in Texarkana. That town is a little more than 30,000 people, and I think it's much more likely that the hospital did not have the staff available to deal with this patient than because of laws that exist.

Anonymous said...

Dr. Hassman,

Please do not assume that the article is correct. I know that hospitals keep patients against their will without the proper paperwork, because I have been a patient. They put me in a cage (tiny room with a metal door and mesh covered window) when I was brought in by a therapist (not a police officer), and a security guard stood outside the door until they got the paperwork they needed even though I was not talking. So, I'm not getting the article's claim that hospitals cannot hold patients, because they certainly do hold them.

I think the article said the patient was in a hospital in Texarkana. That town is a little more than 30,000 people, and I think it's much more likely that the hospital did not have the staff available to deal with this patient than because of laws that exist.

Anonymous said...

I was wrong about the town - the article said Texoma not Texarkana, there's a big difference there.

I also meant to say in my previous post, "I know that hospitals keep patients against their will until they can secure the proper paperwork."

Also, I don't recall if the article stated whether or not the ER doctor called police out of concern for the patient/public's safety. It says he tried to obtain an emergency detention. Why didn't he call the police? That's what my therapist did and the police were at my house in 5 minutes. So rather than change the laws, why didn't they use the laws they have? Sounds like somebody dropped the ball.

jesse said...

@FAP, you are right about this, I was not clear. Maryland's state hospitals are not equivalent to those in Texas, and those psychiatrists working with a predominantly well-off population have luxuries not afforded to our colleagues who work in very different settings. So I accept that what you say is true. Dinah describes in her blog what happened to a very sick man, and it is terrifying.

Dinah is in Annapolis today testifying to try to protect patients from changes in the gun laws. She is an ardent and tireless advocate for the mentally ill. Let's wish her well today.

Anonymous said...

Dr. Hassman--much as I admire a psychiatrist who quotes Dr. Spock, from Star Trek II, the Wrath of Khan, I have to disagree with you. "The needs of the many outweigh the needs of the few" is a concept that is nowhere embodied in U.S. constitutional jurisprudence. In fact, much of the Bill of Rights is specifically anti-majoritarian. You were perhaps thinking of the utilitarian ethical philosphy of Jeremy Bentham and others. And while the various ethical philosophical theories, including ultilitarianism, make for interesting discussion over drinks, they aren't necessarily good social policy.

Jesse--I think you have me and the anonymous commenter from Texas confused, not that I disagree with anything that that the Texas commenter is saying.

First Anonymous Poster

Joel Hassman, MD said...

Having been in a position involving mental health care, where I was in the minority status of a matter that I had to do what benefited the needs of the many, and how it played out for me rather sucked, decisions that involve situations like involuntary commitment fit exactly that adage most of the time. And, to be frank, those who want to continue to take me to task about this matter seem to allude to why people wind up being involuntarily committed to care in the first place.

As I have said before, being hospitalized whether by choice or by force is almost always NOT a pleasant experience, and I would offer further neither is it for a somatic reason either! What I think many commenters are missing is the fact that you are here now to bitch and moan about it, which is the point I think we as clinicians are trying to make here.

Better to endure a long and healthy hate from those seen as punished, than a long and unhealthy regret from ourselves and others who acted as best possible in caring.

Understand that last sentence and this thread will probably be quick to end.

Have a nice weekend, I am done with my point of view here. You might want to read a recent post at my blog to get a further understanding of what I sense I am dealing with at sites like this, but, your time and energy. Just look for Leo D.

Oh, and to Dinah, hope your time, energy, and money via parking in Annapolis was worth it. Thank you for your efforts!

Alison Cummins said...

I've signed my beloved's living will. I have told him that I can't promise him that I'll make the right decision at the right time, just that I'll do my best given what I know about him.

Anonymous said...

Not to belabor the point, but I'd like to add a few thoughts on utilitarianism, because it seems to be driving so much of the current legislation targeting the mentally ill and because it's such a pernicious philosophy.

"The needs of the many outweigh the needs of the few" has a great deal of appeal to some because...well, because the many are many, and the few are few. So if you're one of the many, it's a great philosophy. If you're one of the few, not so much. And the few tend to be the weak, the powerless, the poor, the disenfranchised.

Taken to its logical conclusion, that form of utilitarianism could be used to justify everything from infanticide of those born disabled or just poor, to euthanasia of the frail elderly, to any number of things that are patently evil. Of course, we could never allow those outcomes, because we're a moral society (the philosophical grounding of those morals is a much longer discussion). We defend the defenseless. So then the formulation becomes "the needs of the many outweigh the needs of the few, unless the many decide the few are worthy."

So great, we can trust the many to decide which of the few are worthy, right? Because it's easy. It's easy when the many are the children of Newtown and the few is Adam Lanza. It's easy when the many are the innocent midnight movie goers and the few is James Holmes.

But what about when the few is just me, who has never harmed anyone in my life, who gets up every weekday morning and rides my bike ten miles to my office, does my job and rides home, who pays my taxes and my mortgage and is in all regards an upstanding citizen? Well, wait a minute, you say, that doesn't make you one of the few, it makes you one of the many! Congratulations! Nope. I carry the mental illness tag, and to the many out there, that means I'm one of the few. I can have my rights stripped by the many in the name of their best interests.

Sorry for this long-winded comment, but all the paranoia and vituperation being directed at the mentally ill in today's legislative climate has me more than a little unnerved. I know some of you doctors feel a little under attack on this blog, and rightly so, but imagine what it feels like to be labeled mentally ill these days.

First Anonymous Poster

Anonymous said...

One last comment, and then, like Dr. Hassman, I will decamp from this comment thread.

Jesse--I don't think psychiatrists or mental health professionals are uniformly bad, though of the three psychiatrists I've seen, two were dreadfully bad. I consider the Shrink Rappers (and of course you're an honorary Shrink Rapper)to be part of the solution, not part of the problem. Your description of the way you deal with your patients sounds lovely, or at least as lovely as it can get when dealing with suicidal and destructive thoughts. I wish it were the norm.

Dinah, good luck with the legislative testimony and thank you. In my career I've spent way too much time sitting in legislative committee hearings and you have my sympathy.

If any Shrink Rapper ever has the time and inclination it would be interesting to read about what you would do to fix the mental health system, particularly the issue of involuntary hospitalization, if you had unlimited funds and political resources. You've been in the trenches, it would be great to hear your thoughts.

Thanks for the conversation.

First Anonymous Poster

mctps said...

I find the utilitarian argument somewhat obsolete. Did some of you miss the era of human rights? The meaning of human right is a right so fundamental that it shouldn't be violated even if it were beneficial to do so. It doesn't matter whether happiness is increased or decreased by violating someone's human rights. You just don't violate them, period. Dignity is more important than some slight adjustments in the overall happiness of mankind. I think that's the point. You are free to side with vegetables, pigs, and insects to disagree.

Due process or no process. What is so hard to get about that? If someone is a danger, then there needs to be a law against threaths, for example, as there is in many countries. Then there needs to be evidence and a fair trial. Pretty simple.

I've personally been kept in a mental institution against my will for thirty (30!) days because during the evaluation period I occasionally laughed to myself. That was definite proof of psychosis in the eyes of the responsible psychiatrist. Yeah, I sometimes have amusing thoughts even, perhaps especially, in places that are hateful. I have an inner life as if I were alive and all that, and I have a sense of humor like ordinary mortals. How is any of that a crime?

I never did get a single indication there was anything more to the diagnosis than that, unless it was the non sequitur that since I had had a psychotic episode once before I was fair game. The slightest of indications would be interpreted as incontestable proof justifying weeks of hospitalisation. Bizarre. But typical. I'm sure there's a word for that kind of habitual bizarness in the thought processes of humans and various expert groups in particular.

I had been committed because my psychiatrist suspected I might have psychotic depression due to what that person saw as "irrationally" low hopes regarding my future. I'm a paranoid schizophrenic. Is it so irrational to think I won't ever be able to find, create, and succeed in a career that I would enjoy? I guess being disillusioned and cynical is now the worst kind of chemical imbalance you could have, and merits being treated like a pet dog sans the affection.

Of course, I also talked about suicide, as usual back then. Maybe I talked about it a bit too much that time, but where I live suicidal ideation, even plans of suicide, aren't enough to commit a person. Only suspicion of psychosis is enough. Nothing else is. And even then it's the last recourse, has to be, according to the law.

I now figure it doesn't matter what is written on some piece of paper. If it's not enforced than it could be the word of God itself and it wouldn't make any difference.

mctps said...

It's true, innocent people are often found guilty even through due process. I, for one, am as outraged about that as about anything. Just another proof this isn't so much about laws, it's about laws not being respected. Innocent until proven guilty. Not "until some evidence or indication of possible guilt". No, until PROVEN guilty.

We have all these noble principles but if no one even understands them then what's the point? This is exactly why people and governments should have the minimum amount of power over others. They're shabby and they're composed of shabby people, and the more power you give them the more power there is for them to abuse, which is what they'll do half of the time if not more often according to any statistical method you might like to use for looking at it. Even if it's half good and half bad, that balance of good and evil is achieved at the expense of dignity. Echoes of the first paragraph.

Sorry, it's not good intentions that are the problem, it's lack of clear understanding of even basic concepts, such as human rights, psychosis, guilty, diagnosis, or what the law says is legal.

No wonder we have all these problems when psychiatrists don't even touch philosophy or critical thinking while at the same time they allow themselves to be trained by the drug companies, basically. Yeah, who needs to read all these studies critically and make FOIA requests to get an unbiased sampling when I can just sit in a room and earn a fortune by doing nothing in particular as far as any merit or value is concerned, and I don't mean revenue to the drug companies.

Group think is worse than no think at all. Can you imagine conducting antipsychotic trials without differentiating between rational delusions and irrational delusions? It's the norm though, as I mention at my blog (my handle links to it, I advise you to read that page with care). I personally can't imagine a species so incompetent that it has failed to produce a single person who would've pointed out this huge methodological flaw in decades of widely cited studies in a way accessible to Google. Shabby people with shabby ideas derived from group consensus. Trying to save the world. I wouldn't use the word 'hell' in this connection, I'd just use the word 'comedy'.

mctps said...

P.S. The suspicion of psychotic depression came due to my allegedly irrationally low expectations. As if they had been a delusion or something like that. As if it weren't normal for someone who's depressed to expect little from the future.

My psychiatrist didn't claim those expectations caused the psychosis, just that they were evidence of it. I think I failed to express that fact adequately.

Also, during the evaluation period after commitment, the psychiatrist there claimed to have noticed me laughing to myself once. It's not like someone was talking with me and I was laughing uncontrollably for no reason. It was that I was probably sitting alone, trying to pass time, deep in my thoughts, which must have been amusing when by accident that person noticed me laughing to myself. (I thought some elaboration was necessary here as well.)

I also failed to include an important fact: the psychiatrist knew I didn't like that place, and believed I would attempt to talk myself out of there. In other words, the psychiatrist thought I wasn't trustworthy. But then, that doesn't really explain why I was kept there for a month for no good reason. I guess instead of "sane until proven insane", they used the principle "insane until proven sane" in my case. And of course there was no way for me to prove myself sane because no matter what I said I wouldn't have been trusted. What a nice way to deal with someone.

Also, the only "charge" against me has ever been that I was a danger to myself. I've never done anything in my life, ever, to deserve incarceration. I've never even actually attempted to kill myself. In this country, convicted rapists regularly escape actual prison time because the law is so lenient. So I've been punished for the non-existent crime of being a danger to myself, more severely than the average rapist. What's the word for that? Oh right, insane.

Of course, I was even more a danger to myself that time after I finally got out.

There also were a few people there I pitied especially, who seemed perfectly normal and unable to cope with the boredom a lot of the time. One was finally released after enough desperation had been expressed and tears had been shed, but the more manly among the patients have no access to that escape route. I won't compare it to torture, as I want to avoid diluting a word that refers to something nightmarish and lifelong consequences, but I'll say it wasn't nice. I'll never read a Kafka story in the same way again.

Of course, what happened to me is just one of those very few somewhat unfortunate things that never really happen to an extent anyone should care about, because shit happens and all that. Except mine isn't even the one of the worst I've witnessed. I haven't witnessed very much, yet I've witnessed a few quite bad cases similar to mine except worse. I guess either I have an ability to empathise in a way that the psychiatrists, lacking the required experiences or imagination, do not and therefore don't register such cases; or my experiences are some sort of statistical Big Foot event.

Anyway by "law against threats" I mean a law that criminalises making threats of violence.

Anonymous said...

Mctps,

I was more of a danger to myself after I got out also. That is what Dr. Hassman doesn't seem to want to understand. I get that he wants to believe that he has saved everyone he has forcibly hospitalized, but if hospitalization there is anything like Texas I think it is much more likely that patients left worse than they went in, many have avoided further care, and/or a great number have joined anti-psychiatry groups.

People need to look at what inpatient psychiatric hospitalization looks like in Texas (and I suspect in other states as well) because it is not good. It should say something that they have not noticed a girl inpatient with a broken arm hanging limp at her side. It should say something that a PA changes her major because of the way patients were treated inpatient.

And, Dr. Hassman I do not hate psychiatry. I see a psychiatrist. But, I wouldn't see him if he admitted to some of those places. They are terrible.

The other anonymous makes a good point about utilitarianism. There needs to be more consideration of what the patient needs.

mctps said...

One psychiatrist in America claimed they do it to escape personal consequences: if the patient kills himself, the psychiatrist will be held responsible if he can't prove he didn't act "negligenty". If that's true then it's a good idea to never tell them about suicidal thoughts, period. Of course, that's what I'm determined to do for the rest of my life just to decrease the probability of being perceived as deserving of hospitalisation, unless the drug companies finally come up with an antidepressant that actually works.

Then again, there are psychiatrists who don't hospitalise their patients at the drop of a hat, as you say, so maybe the above is just an excuse for laziness or something like that.